We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes.
- Authors
Ghetti, Simona; Kuppermann, Nathan; Rewers, Arleta; Myers, Sage R.; Schunk, Jeff E.; Stoner, Michael J.; Garro, Aris; Quayle, Kimberly S.; Brown, Kathleen M.; Trainor, Jennifer L.; Tzimenatos, Leah; DePiero, Andrew D.; McManemy, Julie K.; Nigrovic, Lise E.; Kwok, Maria Y.; Perry III, Clinton S.; Olsen, Cody S.; Casper, T. Charles; Glaser, Nicole S.; Perry, Clinton S 3rd
- Abstract
<bold>Objective: </bold>This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors.<bold>Research Design and Methods: </bold>We prospectively enrolled 758 children, 6-18 years old, who presented with DKA in a randomized multisite clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. A total of 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled.<bold>Results: </bold>Among all patients, moderate/severe DKA was associated with lower intelligence quotient (IQ) (β = -0.12, P < 0.001), item-color recall (β = -0.08, P = 0.010), and forward digit span (β = -0.06, P = 0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β = -0.08, P = 0.04). Among previously diagnosed patients, repeated DKA exposure and higher HbA1c were independently associated with lower IQ (β = -0.10 and β = -0.09, respectively, P < 0.01) and higher HbA1c was associated with lower item-color recall (β = -0.10, P = 0.007) after hypoglycemia, diabetes duration, and socioeconomic status were accounted for.<bold>Conclusions: </bold>A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.
- Subjects
TYPE 1 diabetes; DIABETIC acidosis; GLYCEMIC control; GLYCOSYLATED hemoglobin; COGNITIVE ability; HYPERGLYCEMIA; FLUID intelligence; RESEARCH funding
- Publication
Diabetes Care, 2020, Vol 43, Issue 11, p2768
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc20-0187